Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions

Background PEA is often seen during resuscitation, either as the presenting clinical state in cardiac arrest or as a secondary rhythm following transient return of spontaneous circulation (ROSC), ventricular fibrillation/tachycardia (VF/VT), or asystole (ASY). The aim of this study was to explore an...

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Authors: Norvik, A., Unneland, E., Bergum, D., Buckler, D.G., Bhardwaj, A., Eftestøl, T., Aramendi Ecenarro, Elisabete, Nordseth, Trond, Abella, B.S., Kvaløy, J.T., Skogvoll, Eirik
Format: article
Publication Date:2022
Country:España
Institution:Universidad del País Vasco
Repository:Addi. Archivo Digital para la Docencia y la Investigación
OAI Identifier:oai:addi.ehu.eus:10810/57896
Online Access:http://hdl.handle.net/10810/57896
Access Level:Open access
Keyword:pulseless electrical activity (PEA)
electrocardiography (ECG)
cardiopulmonary resuscitation (CPR)
return of spontaneous circulation (ROSC)
dynamics
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spelling Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisionsNorvik, A.Unneland, E.Bergum, D.Buckler, D.G.Bhardwaj, A.Eftestøl, T.Aramendi Ecenarro, ElisabeteNordseth, TrondAbella, B.S.Kvaløy, J.T.Skogvoll, Eirikpulseless electrical activity (PEA)electrocardiography (ECG)cardiopulmonary resuscitation (CPR)return of spontaneous circulation (ROSC)dynamicsBackground PEA is often seen during resuscitation, either as the presenting clinical state in cardiac arrest or as a secondary rhythm following transient return of spontaneous circulation (ROSC), ventricular fibrillation/tachycardia (VF/VT), or asystole (ASY). The aim of this study was to explore and quantify the evolution from primary/secondary PEA to ROSC in adults during in-hospital cardiac arrest (IHCA). Methods We analyzed 700 IHCA episodes at one Norwegian hospital and three U.S. hospitals at different time periods between 2002 and 2021. During resuscitation ECG, chest compressions, and ventilations were recorded by defibrillators. Each event was manually annotated using a graphical application. We quantified the transition intensities, i.e., the propensity to change from PEA to another clinical state using time-to-event statistical methods. Results Most patients experienced PEA at least once before achieving ROSC or being declared dead. Time average transition intensities to ROSC from primary PEA (n = 230) and secondary PEA after ASY (n = 72) were 0.1 per min, peaking at 4 and 7 minutes, respectively; thus, a patient in these types of PEA showed a 10% chance of achieving ROSC in one minute. Much higher transition intensities to ROSC, average of 0.15 per min, were observed for secondary PEA after VF/VT (n = 83) or after ROSC (n = 134). Discussion PEA is a crossroad in which the subsequent course is determined. The four distinct presentations of PEA behave differently on important characteristics. A transition to PEA during resuscitation should encourage the resuscitation team to continue resuscitative efforts.This work was partially supported by the Spanish Ministerio de Ciencia, Innovacion y Universidades through grant RTI2018-101475-BI00, jointly with the Fondo Europeo de Desarrollo Regional (FEDER), and by the Basque Government through grant IT1229-19. This study has been made possible by DAM foundation and the Norwegian Health Association.Elsevier202220222022info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10810/57896reponame:Addi. Archivo Digital para la Docencia y la Investigacióninstname:Universidad del País VascoInglésinfo:eu-repo/grantAgreement/MICIU/RTI2018-101475-BI00/https://www.sciencedirect.com/science/article/pii/S0300957222001423?via%3Dihubinfo:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by/3.0/es/© 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Atribución 3.0 Españaoai:addi.ehu.eus:10810/578962026-06-18T09:23:17Z
dc.title.none.fl_str_mv Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions
title Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions
spellingShingle Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions
Norvik, A.
pulseless electrical activity (PEA)
electrocardiography (ECG)
cardiopulmonary resuscitation (CPR)
return of spontaneous circulation (ROSC)
dynamics
title_short Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions
title_full Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions
title_fullStr Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions
title_full_unstemmed Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions
title_sort Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions
dc.creator.none.fl_str_mv Norvik, A.
Unneland, E.
Bergum, D.
Buckler, D.G.
Bhardwaj, A.
Eftestøl, T.
Aramendi Ecenarro, Elisabete
Nordseth, Trond
Abella, B.S.
Kvaløy, J.T.
Skogvoll, Eirik
author Norvik, A.
author_facet Norvik, A.
Unneland, E.
Bergum, D.
Buckler, D.G.
Bhardwaj, A.
Eftestøl, T.
Aramendi Ecenarro, Elisabete
Nordseth, Trond
Abella, B.S.
Kvaløy, J.T.
Skogvoll, Eirik
author_role author
author2 Unneland, E.
Bergum, D.
Buckler, D.G.
Bhardwaj, A.
Eftestøl, T.
Aramendi Ecenarro, Elisabete
Nordseth, Trond
Abella, B.S.
Kvaløy, J.T.
Skogvoll, Eirik
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv pulseless electrical activity (PEA)
electrocardiography (ECG)
cardiopulmonary resuscitation (CPR)
return of spontaneous circulation (ROSC)
dynamics
topic pulseless electrical activity (PEA)
electrocardiography (ECG)
cardiopulmonary resuscitation (CPR)
return of spontaneous circulation (ROSC)
dynamics
description Background PEA is often seen during resuscitation, either as the presenting clinical state in cardiac arrest or as a secondary rhythm following transient return of spontaneous circulation (ROSC), ventricular fibrillation/tachycardia (VF/VT), or asystole (ASY). The aim of this study was to explore and quantify the evolution from primary/secondary PEA to ROSC in adults during in-hospital cardiac arrest (IHCA). Methods We analyzed 700 IHCA episodes at one Norwegian hospital and three U.S. hospitals at different time periods between 2002 and 2021. During resuscitation ECG, chest compressions, and ventilations were recorded by defibrillators. Each event was manually annotated using a graphical application. We quantified the transition intensities, i.e., the propensity to change from PEA to another clinical state using time-to-event statistical methods. Results Most patients experienced PEA at least once before achieving ROSC or being declared dead. Time average transition intensities to ROSC from primary PEA (n = 230) and secondary PEA after ASY (n = 72) were 0.1 per min, peaking at 4 and 7 minutes, respectively; thus, a patient in these types of PEA showed a 10% chance of achieving ROSC in one minute. Much higher transition intensities to ROSC, average of 0.15 per min, were observed for secondary PEA after VF/VT (n = 83) or after ROSC (n = 134). Discussion PEA is a crossroad in which the subsequent course is determined. The four distinct presentations of PEA behave differently on important characteristics. A transition to PEA during resuscitation should encourage the resuscitation team to continue resuscitative efforts.
publishDate 2022
dc.date.none.fl_str_mv 2022
2022
2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/10810/57896
url http://hdl.handle.net/10810/57896
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/grantAgreement/MICIU/RTI2018-101475-BI00/
https://www.sciencedirect.com/science/article/pii/S0300957222001423?via%3Dihub
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by/3.0/es/
Atribución 3.0 España
eu_rights_str_mv openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/3.0/es/
Atribución 3.0 España
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Addi. Archivo Digital para la Docencia y la Investigación
instname:Universidad del País Vasco
instname_str Universidad del País Vasco
reponame_str Addi. Archivo Digital para la Docencia y la Investigación
collection Addi. Archivo Digital para la Docencia y la Investigación
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,301603

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